Bodade Pankaj R, Mody Rajendra N
Department of Oral Medicine and Radiology, Vidarbha Youth Welfare Society's Dental College and Hospital, Amravati, Maharashtra, India.
Oral Health Dent Manag. 2013 Jun;12(2):65-72.
The overall aim of this pilot study was to establish the role of dental practitioners in identifying patients at risk of osteoporosis from panoramic radiographs.
The pilot study evaluated 32 randomly selected postmenopausal women with no known secondary cause of bone loss. A panoramic radiograph of each patient was taken and qualitative and quantitative radiomorphometric indices were determined. Bone mineral densities of the mandible and lumbar vertebrae were measured by dual energy x-ray absorptiometry. Using World Health Organization criteria, patients were divided into normal, osteopoenic and osteoporotic categories. The relationship of qualitative and quantitative indices with bone mineral densities of the mandible and lumbar area was analysed statistically.
Significant positive correlation (Pearson coefficient) was observed between bone mineral densities of the mandible and bone mineral densities of lumbar vertebrae. There was significant (P<0.05) association between the mandibular cortical index (MCI) and osteoporosis (chi-square test), incidence of osteoporosis increased from group C1 to C2 to C3. Strong positive correlation (Pearson coefficient) was observed between all quantitative indices and bone mineral densities of lumbar vertebrae. Intra-observer and inter-observer reproducibility for the quantitative indices was poor (paired and unpaired t-tests, respectively). However, it was excellent for the mandibular cortical index (kappa coefficient).
The mandibular cortical index, a qualitative index based on morphological changes in the inferior cortex observed on panoramic radiograph, is useful tool for the screening of postmenopausal osteoporotic patients. Quantitative indices (mental index, inferior and superior panoramic mandibular indices, antegonion index and gonion index), although well correlated with skeletal bone loss, were not useful because of their poor reproducibility. A study with a larger sample is needed to confirm the results from this pilot.
本初步研究的总体目的是确定牙科医生在通过全景X线片识别骨质疏松风险患者方面的作用。
该初步研究评估了32名随机选取的无已知继发性骨质流失原因的绝经后女性。为每位患者拍摄全景X线片，并确定定性和定量的放射形态计量指标。通过双能X线吸收法测量下颌骨和腰椎的骨密度。根据世界卫生组织标准，将患者分为正常、骨量减少和骨质疏松类别。对定性和定量指标与下颌骨和腰椎区域骨密度的关系进行统计学分析。
观察到下颌骨骨密度与腰椎骨密度之间存在显著正相关（皮尔逊系数）。下颌骨皮质指数（MCI）与骨质疏松之间存在显著关联（P<0.05，卡方检验），骨质疏松发生率从C1组到C2组再到C3组呈上升趋势。观察到所有定量指标与腰椎骨密度之间存在强正相关（皮尔逊系数）。定量指标的观察者内和观察者间重复性较差（分别为配对和非配对t检验）。然而，下颌骨皮质指数的重复性极佳（kappa系数）。
下颌骨皮质指数是基于全景X线片观察到的下颌骨下缘皮质形态变化的定性指标，是筛查绝经后骨质疏松患者的有用工具。定量指标（颏孔指数、上下颌全景指数、下颌角前切迹指数和下颌角指数）虽然与骨骼骨质流失相关性良好，但由于其重复性差而无用。需要进行更大样本量的研究来证实本初步研究的结果。
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